# INTERNATIONAL COSMETIC SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629383732
- **Authorized official:** CARROLL LESESNE (MEMBER)
- **Authorized official phone:** (212) 570-6318

## Contact information

- **Practice address:** 620 PARK AVE, NEW YORK, NY 10065-6591
- **Practice address phone:** (203) 661-8231
- **Mailing address:** 2 MERCIA LN, GREENWICH, CT 06830-7068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 161137-2 | NY | Yes |

## Other

- **Enumeration date:** 08/12/2010
- **Last updated:** 08/12/2010